Suddenly my Centrals got a lot more disruptive

[tcinoz]

One of the most frustrating things about this CPAP journey is tweaking the settings and everything is hunky dory for the first part of the night, then it all goes to sh*t in the final two or three hours, with clusters of events that make you wonder if you're even using the right machine for the job. This pattern happens a lot with me.

   

[stevew168]

Yes, I know what you mean. I used to have the same pattern with central apneas, later in the night. Those are probably caused by REM sleep which lasts longer in the later period of sleep. Your muscles become more tonic and your brain might even be less sensitive to the buildup of CO2, resulting in more centrals. Centrals suck, you feel awful the next day. I know. Luckily I got an ASV paid for by my insurance, not because I had more central apneas than obstructives in my sleep test, but due to the Cheyne-Stokes breathing that I had documented to my sleep doctor with OSCAR. You may also have examples if you use OSCAR Overview to look for CSR or Periodic Breathing in the past.

 If you cannot get proper relief, go for the ASV. It has been a game changer for many with central apneas. Best to you!

[tcinoz]

Yes, I know what you mean. I used to have the same pattern with central apneas, later in the night. Those are probably caused by REM sleep which lasts longer in the later period of sleep. Your muscles become more tonic and your brain might even be less sensitive to the buildup of CO2, resulting in more centrals. Centrals sunck, you feel awful the next day. I know. Luckily I got an ASV paid for by my insurance, not because I had more central apneas than obstructives in my sleep test, but due to the Cheyne-Stokes breathing that I had documented to my sleep doctor with OSCAR. You may also have examples if you use OSCAR Overview to look for CSR or Periodic Breathing in the past.

 If you cannot get proper relief, go for the ASV. It has been a game changer for many with central apneas. Best to you!

Thank you, Steve - I appreciate your interest. Good to hear that you resolved the issues you were facing.

Yes, you're right - two or three of my charts have shown these clusters of CAs as Cheyne-Stokes events. I'm not sure how they decide to categorize them as such some of the time and not other times where the pattern looks identical, but anyway... even though I'm not particularly flush with cash I probably would have bought a ASV by now with my own money (heart issues permitting) had I not needed a prescription from an authorised doctor to proceed. I'll have to wait till my next review and cardiologist appointment in May/June but I wouldn't be surprised if that's how things end up.

Meanwhile, I'm wondering if I should use different CPAP settings for the REM phase of my sleep - maybe EPR ramped up to 3? It wouldn't be hard to implement - I wake up several times during the night. I might start experimenting with that idea now.

[stevew168]

Raising EPR might increase your central apneas, due to the possibility of increasing your tidal volume, causing less CO2 in your bloodstream. But it's worth a try. If you increase EPR to 3, I'd suggest increasing your minimum pressure to 7 or 8, since the EPR will lower EPAP, which cannot go below 4. You could also try lowering your maximum pressure to 11 since you don't have very many hypopneas, but if they increase without any improvement in CAs, move it back up.

[tcinoz]

Raising EPR might increase your central apneas, due to the possibility of increasing your tidal volume, causing less CO2 in your bloodstream. But it's worth a try. If you increase EPR to 3, I'd suggest increasing your minimum pressure to 7 or 8, since the EPR will lower EPAP, which cannot go below 4. You could also try lowering your maximum pressure to 11 since you don't have very many hypopneas, but if they increase without any improvement in CAs, move it back up.

For the last two nights I've had the starting pressure at 6.8 with a short ramp time to a range of 8.6 to 11.2, EPR 2, and the 'soft' option switched on.

I don't want to tempt fate but so far it's worked better than I could have hoped for, although with too many 'arousals' to say I feel well-rested and clear-headed when I get up in the mornings, but still - it's a big leap forward.

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[tcinoz]

So I'd been going OK, with lowish AHI numbers and fewer arousals than in the early days, until a few days ago when I had renewed contact with the partner I split from a few months ago. (It was during our split-up that my sleep apnea first started manifesting itself.) Suddenly my AHI numbers have averaged 3 or 4 times what they were averaging before. I mention this personal aspect as an indication of the effect that anxiety can have on our sleep disorders; it seems to be an under-reported phenomenon.

In the three charts below, all from the last week or so, the settings were pretty much the same, yet the results varied wildly.

The first one has my lowest AHI score ever, the second one is a more typical recent average night, and the third one is post-stress trigger a couple of nights ago. (Last night the AHI was 4.5)

My question to anyone prepared to have a go at shedding some light on this recent development is what are the treatment implications? I was hoping with the decreasing number of centrals that my sleep doctor's claim that my CAs might just have been treatment-emergent ones was justified, but now they have returned with a vengeance (in bursts) I'm not sure what to make of it all. And if my settings worked pretty well last week, why do they no longer work - do I need to tweak them according to my anxiety levels? 

Any insights would be much appreciated - including whether 0.12 - 0.15 at 95% is an acceptable flow limit average. Thank you.

               

[tcinoz]

And then last night, this - my worst night since I started CPAP - after receiving an unwelcome text message just before bedtime.
My apneas are definitely anxiety related.

(I switched to CPAP mode from audo-mode during the night because my breathing was so shallow I kept drifiting in and out of sleep with the build-up of air in my mouth.)

I need an ASV, don't I?


         

[Sleeprider]

I think way back in this thread I suggested ASV. https://www.apneaboard.com/forums/Thread...#pid506277 How do you want to proceed? ASV is not the easiest or cheapest thing to get in AU. Your best bet may be CPAPspecials if they can acquire the device to send.

[tcinoz]

I think way back in this thread I suggested ASV. https://www.apneaboard.com/forums/Thread...#pid506277  How do you want to proceed?  ASV is not the easiest or cheapest thing to get in AU. Your best bet may be CPAPspecials if they can acquire the device to send.

Thanks Sleeprider - yes, you did suggest an ASV, although since then my CAs went right down (AHI regularly below 1.0) to the point where I thought they might have been the 'treatment emergent' variety after all. Now I'm reassessing everything. Weird what stress can do!

I guess my point of re-raising it is that maybe CAs that fluctuate as wildly as mine aren't so obviously equipment-dependent if under normal circs an ordinary CPAP machine does the job. I wondered too if there was a danger of my brain getting used to the enhanced sophistication of an ASV machine to the point where it (my brain) might get lazy and prevent any healing that might otherwise have taken place?

Thanks again for your insights. I'll bear CPAPspecials in mind.

[SarcasticDave94]

If this wasn't mentioned before, I'll add this in now, Central Apnea have the nasty little habit of being consistently inconsistent. This means that their numbers will rise and fall unpredictably and without an easily identifiably cause.

If you're in the position that they're being a problem, then you're better off with treating via ASV. The CA should not bother you after a properly set ASV is involved.